Objective: There is a debate regardingthe timing of tracheostomy in
trauma patients. This study aimed to assess the effect of early
tracheostomy (ET; [less than or equal to] 7 days) in the outcomes
associated to hospital stay. Methods: A historical cohort study was
undertaken using charts of patients admitted to Puerto Rico Trauma
Hospital (PRTH) who required mechanical ventilation (MV) and underwent
tracheostomies, 2000-2013. A logistic regression was done to evaluate
the association between timing of tracheostomy vs. complications and
mortality ratio. To estimate the relationship between ET and outcomes
related to hospital stay, a binomial-negative regression was performed.
A p<0.05 was considered statistically significant. This study was IRB
approved: B0030714. Results: A total of 1,134 patients were evaluated;
313 of whom were ETs and 821, late tracheostomies (LTs). ET patients had
a lower ISS compared to their counterparts (p=0.004). ET patients showed
lower complications (Respiratory Failure OR=0.61, CI95%: 0.45-0.84; ARDS
OR=0.44, CI95%: 0.300.64; Pneumonia OR=0.53, CI95%: 0.40-0.71;
Septicemia OR=0.48, CI95%: 0.33-0.70; Bacteremia OR=0.59, CI95%:
0.40-0.86) than LT patients. Those with ET had lower MV days
(RRadj.=0.74, CI95%: 0.68-0.82), ICU days (RRadj.=0.66, CI95%:
0.59-0.73), and LOS (RRadj.=0.74, CI95%: 0.69-0.80) compared to those
with LT, after adjusting by age, ISS, and complications. However, there
were no differences in mortality rate (ORadj.=0.66, CI95%: 0.44-1.01)
among ET and LT patients, after adjusting for confounders. Conclusion:
Our results suggested that ET reduced complications, MV days, ICU days,
and LOS, having an indirect effect on mortality ratio. Standardized
protocols of ET are recommended to enhance health outcomes in trauma
patients.